LONG-TERM QUALITY OF LIFE AND POSTTRAUMATIC STRESS FOLLOWING CARDIAC SURGERY: A 5-YEAR FOLLOW-UP STUDY.

Abstract

<h3>Objective</h3> Heart surgery can have a significant negative effect on patients' quality of life (QoL) and may cause long-term posttraumatic stress reactions. We aimed to estimate the longitudinal change and predictors of health-related quality of life (HRQOL) and identify factors associated with posttraumatic stress (PTS) at 5-year follow-up after elective cardiac surgery. <h3>Methods</h3> Single-centre prospective study was conducted after Regional Bioethics Committee approval. Adult patients undergoing elective cardiac surgery at tertiary heart center were enrolled in the study. HRQOL was measured using the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) questionnaire before and 5-years after cardiac surgery. PTS was assessed using the International Trauma Questionnaire. To estimate change in eight domains of HRQOL assessment between two measurement points (preoperativelly and 5 years after surgery) we performed statistical analysis using multivariate latent change modeling. <h3>Results</h3> A total of 286 patients were enrolled into the study. At 5-year follow-up 210 patients were contacted and included into final data analysis. Median age was 62.29 [19–84] years, and 70 % were male. 65 % of study participants underwent coronary artery bypass grafting (CABG). All study participants achieved statistically significant (p<0.001) improvement in Physical Functioning (PF) Mental Health (MH), Vitality (VT) and Social Functioning (SF) domains of HRQOL assessment. No significant shift was observed in General Health (GH) (p=0.067), Bodily Pain (BP) (p=0.248) and composite scores of Role Problems (RP (p=0.686)) and Emotional Problems (RE (p=0.169)) domains 5 years after surgery. Significant gender effects were found on mean levels of GH (βintercept=0.17, p=0.003), PF (βintercept=0.19, p<0.001), BP (βintercept=0.19, p<0.001), MH (βintercept=0.14, p=0.006), VT (βintercept=0.24, p<0.001) and SF (βintercept=0.11, p=0.019), indicating higher scores of these HRQOL domains before heart surgery in men, compared to women. There were no differences in the moderating effects of age, dyslipidemia, hypertension, reduced EF and higher EuroScore II. Patients undergoing valve and combined surgery reported a significant increase in GH, while this change was not observed in the CABG group. In total, 4 (1.9%) patients met the diagnostic criteria for cardiac surgery-related PTSD at 5-year follow-up. <h3>Conclusions</h3> There was an improvement in HRQOL five years after cardiac surgery. Lower rates of all SF-36 domains before surgery, valve and combined surgery were associated with more signifficant HRQOL improvement. Female gender was associated with lower scores in HRQOL before heart surgery, and poorer improvement of physical functioning in comparison to male patients. The incidence of PTSD was 1,9 % in a sample of cardiac patients at 5-year post cardiac surgery.